Provider Demographics
NPI:1578581880
Name:LAVERTY, ELIZABETH LARA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LARA
Last Name:LAVERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 S BUMBY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8704
Mailing Address - Country:US
Mailing Address - Phone:407-894-0005
Mailing Address - Fax:407-894-7759
Practice Address - Street 1:2881 S BUMBY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8704
Practice Address - Country:US
Practice Address - Phone:407-894-0005
Practice Address - Fax:407-894-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2934222363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ23055Medicare UPIN
FLU3300ZMedicare ID - Type Unspecified